The IVF treatments that don't work

IVF brings fertility joy to the one in seven heterosexual couples in the UK who are struggling to conceive – two per cent of all babies in the UK now are born through it. But the costs – both financially and emotionally – are enormous.

At upwards of £5000 per cycle – and the UK National Institute for Health and Care Excellence (NICE) recommends three cycles – couples can end up shelling out over £15,000 for treatment, and that's without all the add-on treatments fertility clinics offer, which can cost anything from £50 for a screening blood test to £8000 for egg freezing.

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One of the worst examples of healthcare ever

The revelation by BBC Panorama that fertility clinics may be prescribing many of these treatments without having any scientific evidence to prove they work is shocking. In the programme, aired this month, Professor Carl Heneghan, who led the research, called it one of the worst examples of healthcare practice he had ever seen in this country.

Couples going through a vulnerable and desperate time in their lives are not only being left out of pocket, they are being misled by the very health professionals they have put their trust in.

Getty ImagesScience Photo Library - ZEPHYR

What did the research show?

The research was made up of two studies: the first one reviewed the claims made about add-on IVF treatments on the websites of all fertility clinics in the UK. Elizabeth Spencer's team at the University of Oxford, UK found that out of the total 276 claims being made across 74 websites, only 13 websites included references to scientific research papers to support these claims, 12 references of which were studies with poor design or methods. Only five referenced high-level evidence.

The second study, carried out by Dr Carl Heneghan's team, also from the University of Oxford, looked at the evidence behind the treatments themselves. Of the 38 treatments they reviewed, only 11 are recommended by NICE – which provides national guidance in healthcare.

Only one add-on treatment – endometrial scratching – a technique where the lining of the uterus is superficially injured in the hope that the repair process makes the uterus more receptive to an implanting embryo – was shown to improve birth rates from IVF.

Even this had only moderate-quality evidence, which showed the process is only beneficial in women with more than two previous embryo transfers.

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There has, however, also been doubt cast over the long-term harms of endometrial scratching. A clinical trial in the UK is currently underway.

It is important to note that some add-on treatments are necessary in some patients. Professor Adam Balen, Chair of the British Fertility Society (BFS) and spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG), told NetDoctor: "Some 'add-on' treatments that have been in the news recently are in fact standard investigations and procedures that are required in certain circumstances."

"For some interventions there may be some evidence of improvement in live birth rates in some situations. Other treatments such as intralipid infusions are not recommended."

It is this lack of transparency from clinics that is cause for concern.

"Doctors in clinics in the private sector have a duty to consumer protection, not only to the General Medical Council (GMC), but under consumer protection laws, to make sure patients get all the information."

Ask your doctor lots of questions, Cohen advises. "Doctors are experts, but ultimately, you're the one that's having stuff done to you and your body, so don't be frightened to ask questions."

4. Request evidence

If you are offered add-ons, ask for the evidence.

"As consumers or patients, if we don't ask whether there's high-quality evidence but we're going to pay - then there's no incentive for clinics to give it to us – demand and supply. You've got to decide whether you're prepared to pay for that 'I don't know'," warns Cohen.

5. Use your money wisely

"If you've got a set amount of money, work out whether paying for the extra add-ons is worth it - in terms of the evidence they have for improving success rate - or if you'd be better off paying for another cycle," she adds.

6. Keep an eye out

Look out for an evidence-based website from the HFEA in the new year, which aims to help patients make informed decisions about the add-on treatments they are offered.

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